<b>Objective.
</b>This
study assessed whether a single diabetic ketoacidosis (DKA) episode is associated
with cognitive declines in children with newly diagnosed type 1 diabetes, and
whether the same is true in children who had been previously diagnosed after
accounting for variations in glycemic control and other relevant factors.<b> Design. </b>We prospectively
enrolled 758 children, 6- to 18-years-old, who presented with DKA in a
randomized multi-site clinical trial evaluating intravenous fluid protocols for
DKA treatment. DKA was moderate/severe in 430 children and mild in 328
children. 392 children with DKA had new onset of type 1 diabetes, and the rest were
previously diagnosed. Neurocognitive assessment occurred 2-6 months after the
DKA episode. A comparison group of 376 children with type 1 diabetes, but no
DKA exposure, was also enrolled. <b>Results. </b>Among all patients,
moderate/severe DKA was associated with lower IQ (β=-.12, p<0.001),
item-color recall (β=-0.08, p=0.010), and forward digit span (β=-0.06,
p=0.04). Among newly diagnosed patients,
moderate/severe DKA was associated with lower item-color recall (β=-0.08,
p=0.04). Among previously diagnosed patients, repeated DKA exposure and higher
hemoglobin A1c were independently associated with lower IQ (β=-.10 and β=-0.09,
respectively, ps <.01) and higher hemoglobin A1c was associated with lower
item-color recall (β=-0.10, p=0.007), after accounting for hypoglycemia,
diabetes duration, and socio-economic status.<b> Conclusion.
</b>A
single DKA episode is associated with subtle memory declines soon after type 1
diabetes diagnosis. Sizable IQ declines are detectable in children with known
diabetes, suggesting that DKA effects may be exacerbated in children with
chronic exposure to hyperglycemia.<b> <br>
</b>
Cognitive Function following Diabetic Ketoacidosis in Children with New Onset or Previously Diagnosed Type 1 Diabetes
